PROJECT SUMMARY/ABSTRACT Early Childhood Caries (ECC) is the most common chronic disease among children. American Indian children are 4 times more likely to have untreated dental decay than white children. If left untreated, ECC can lead to chronic pain, loss of teeth, poor nutrition, and impaired growth. The proposed study aims to reduce the burden of ECC in two American Indian communities through an innovative, community based participatory approach. The project will: (1) partner with 2 tribes, the Hopi Tribe in Arizona and the Crow Tribe in Montana, to conduct a formative assessment on oral health; (2) adapt and pilot a ?best practices? intervention to be culturally relevant for each of our tribal communities; and (3) conduct a 2-condition, controlled study to evaluate the impact of the culturally-tailored oral health intervention (compared to a standard prenatal/postnatal healthy lifestyle intervention) on the reduction of the incidence of ECC in young children. Community health representatives (CHRs) will be trained to deliver the interventions with pregnant women and follow them through the first 2 years after birth. The oral health intervention will consist of 4 intervention components known to be effective (best practices) in the prevention of ECC: (1) dietary and oral health education provided during pregnancy and the postnatal period; (2) oral health care of children including the application of fluoride varnish; (3) motivational interviewing with children?s mothers; and (4) patient care coordination/navigation of existing oral health services in each study community facilitated by CHRs. Caries incidence and severity will be compared across both conditions at the 2-year child exam. Mothers? knowledge, attitudes, and behaviors related to ECC will be also measured for both conditions at pre-test and post-test. Surveys will assess each level of the social ecological model. Individual level domains will include: (1) demographics of mother and baby (pre-test only); (2) dental health of the child to date; (3) mother?s and child?s oral health (postnatal); (4) mother?s knowledge, beliefs, and attitudes about best practices in oral health; (5) mother?s perception of self-efficacy and susceptibility; and (6) mother?s prenatal health and experiences. Interpersonal level domains will include: (1) current living situation and family support; (2) availability of emotional, informational, and instrumental support; and (3) perceptions of peers? and family members? attitudes toward caregiving and oral health. Community level domains will include: (1) tribal identity and related experiences; (2) care coordination and access to social and oral health services; and (3) perceptions of cultural congruence of CHR interactions and intervention materials. If successful, this community-based approach may prove to be a feasible method for improving oral health of American Indian children and reducing the burden of ECC in many Native communities with limited access to regular dental care.